Appendix E - National Coverage Determinations Manual / Photosensitive_drugs

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Note:  The following article synopsis was NOT provided by HCPro. It was created by Find-A-Code/innoviHealth.

Article Overview

This page discusses the Medicare manual’s treatment of photosensitive drugs used in photodynamic therapy and highlights a specific drug example in an ocular setting. It is relevant to coders, billers, and clinical documentation staff who need to understand the coverage context, referenced diagnosis and procedure coding, and the distinction between covered and noncovered uses described in the manual.

Why This Topic Matters

Coverage policy for photosensitive drugs can affect whether services and related drug administration are reimbursable under Medicare. The article helps readers identify the policy framework, the clinical setting addressed, and the code sets referenced in the coverage discussion.

Article Sections

  1. Photosensitive drugs

    Introduces the general category of photosensitive drugs and explains their role in photodynamic therapy. Provides the Medicare manual context for the topic.

  2. Verteporfin

    Focuses on a specific photosensitive drug example and its coverage context within ocular photodynamic therapy. Discusses the policy setting, clinical indication framework, and related Medicare references.

What You Will Learn

  • How the Medicare manual frames photosensitive drugs in photodynamic therapy
  • Which clinical area is highlighted for the drug example
  • What general coverage context is described for the topic
  • Which code sets are referenced in the policy discussion

Who Should Read This

  • Medical coders
  • Medical billers
  • Compliance staff
  • Revenue cycle professionals
  • Clinical documentation specialists

Codes Discussed


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